Georgi Ingrid, Georgi Mathias, Haas Johannes-Peter
Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland.
Z Rheumatol. 2024 Feb;83(1):41-51. doi: 10.1007/s00393-023-01454-y. Epub 2023 Dec 29.
Juvenile dermatomyositis (JDM) is by far the most frequent inflammatory myopathy in childhood and adolescence. It is clinically characterized by inflammatory changes of the skin and muscles but as a multisystemic disease can also affect the skeletal system, the gastrointestinal tract, lungs and heart. Intrinsic (multigenetic risk) and extrinsic factors (triggers) are involved in the pathogenesis resulting in endothelial damage, involvement of fascies, activation of the interferon system and autoimmune reactions including formation of myositis-specific autoantibodies (MSA). In contrast to dermatomyositis in adults, in children and adolescents there are no associations with malignant diseases. The variable expression, the rarity of the disease and the risk of long-term damage and complications necessitate pediatric rheumatological experience in the diagnostics and treatment. Recently, new approaches in drug treatment have substantially improved the outcome and prognosis but a multidisciplinary treatment (including physicians, physiotherapists, psychologists, social workers) is mandatory, especially in the first phases of the disease. Particularly important is a professionally correct treatment of the functional sequelae, which are a particular focus of this article.
幼年皮肌炎(JDM)是迄今为止儿童和青少年中最常见的炎性肌病。其临床特征为皮肤和肌肉的炎症性改变,但作为一种多系统疾病,它也可影响骨骼系统、胃肠道、肺和心脏。内在因素(多基因风险)和外在因素(触发因素)参与发病机制,导致内皮损伤、筋膜受累、干扰素系统激活以及包括肌炎特异性自身抗体(MSA)形成在内的自身免疫反应。与成人皮肌炎不同,儿童和青少年患者与恶性疾病无关联。该病表现多样、发病率低,且存在长期损伤和并发症风险,因此诊断和治疗需要儿科风湿病学经验。最近,药物治疗的新方法显著改善了治疗效果和预后,但多学科治疗(包括医生、物理治疗师、心理学家、社会工作者)是必不可少的,尤其是在疾病的最初阶段。对功能后遗症进行专业正确的治疗尤为重要,这也是本文的重点。